Dr. Adel Eldin (29)

As the year 2016 comes to an end and 2017 is here, one must pause and rethink the New Year Resolution. To have a fresh start with the New Year and work on achieving a number of goals which usually include start exercising regularly, loose weight, stop smoking and drinking, spend more quality time with family to enjoy life more, help others, get organized and out of debt.

Aiming to strike a balance between Physical, Mental, Social and Spiritual needs of our body and soul, avoid stress and find activities to enjoy life which are not necessarily extravagant or self serving. Yes, your Heart Health will be optimized with improving your Physical Health, but also when you get out of your comfort zone to serve others without waiting for some kind of a reward. It has been clearly shown that random acts of kindness is a good thing for your Heart Health and also a way to thank our Creator for the endless blessings we took for granted. It is also an opportunity to start having daily self-assessment to be a better human being and to think about ways of improving your performance on the following day when you wake up to help those who are less fortunate.

In other words, to start the New year with spreading peace starting with yourself, then family, friends,coworkers, entire humanity and All Mighty God. This concept of comprehensive Wellness has been an important part of our Health and Wellness Program to go on for the seventh year in 2017 to be implemented not only for few hours or days but rather become a 24/7 life style Resolution. Have a Happy and Healthy New Year everybody!

Do you practice evidence-based Medicine? or you feel you were put in a situation where patient best interest is not being looked at as first priority. But rather as revenue generating for job security especially in the employed physician category!

To put it all in prospective, here are real examples to illustrate this challenge. A 58 year old female patient with persistent dry cough , a tickle in the throat who has seen multiple consultants including Ear, Nose and Throat specialist, then allergy specialist, then a Gastroenterologist ( stomach doctor) who saw patient and performed upper Endoscopy and gave patient anti-reflux medication, but cough continued and a fourth consultant was added being a lung doctor , He did work up including CT scan of the chest which was negative and so was the multiple allergy testing done was negative.

Then I saw the patient and went over carefully her medication list that she was currently taking and Bingo , it was clear that these symptoms were obviously due to side effects of one of the medications she was taking causing her dry cough and tickle in the throat symptoms . This medication belonged to a class of drugs called ACEI , or Angiotensin -Converting Enzyme Inhibitors which after being switched to a different class of medications called ARB or Angiotensin Receptor Blockers that does the same therapeutic benefit without the side effects. Wow, the patient after the switch of medications, dry cough ,throat irritation and the need to clear her throat every couple of minutes miraculously gone! Only, if this was done earlier , could have saved tens of thousands of dollars of unnecessary healthcare money and procedures and achieving better outcome for only few dollars spent instead!

The same can be seen in cholesterol lowering therapy that prevents progression of atherosclerotic plaques or hardening and clogging of the arteries which if left untreated will certainly lead to subsequent clinical events such as Angina or chest pain first on exertion and if left untreated will lead to Unstable angina and acute heart attacks , strokes and peripheral vascular disease leading to gangrene and amputation . That is why we all should address these issues seriously and aim to achieve target numbers for cholesterol and triglyceride lowering by diet, exercise, life style modification with smoking cessation,limit alcohol intake and medications to prevent close to 80% of cardiovascular morbidity and mortality affecting millions of Americans and costing billions of dollars.

86% of every healthcare dollar spent goes to chronic disease management which is largely preventable and achievable on outpatient ambulatory basis with empowering patient through education and advocacy.

The fast changes dynamics of healthcare will dictate the adoption of evidence -based Medicine for cost saving while improving outcome. Similar examples including unnecessary IV therapy including vitamins such as B12 and others , iron, fluids, antibiotics ..etc which can be given orally effectively unless than patient has a malabsorption syndrome and can not hold anything down due to uncontrolled vomiting or diarrhea which is the only justifiable indication then. This will help patient to avoid unnecessary complications such as IV site infection with the risk of introducing Staph infection into the blood stream especially in cases where patient has hardware like pacemakers, defibrillators , artificial heart valves, or joints. This risk increases with every time the integrity of the skin is compromised with needle and catheter insertion plus the so many trips that patient make with some of whom are elderly, frail and can not drive . Adding enormous stress on patients making these trips to justify billing the third parties for these services. And in many cases, the patients are stuck with the bill for unnecessary IV therapy or its complications putting additional stress on the already stressed patient. Believe me, those patients tell me their unfortunate stories.

In brief, patients are fed up with the non sense and they need and appreciate their honest doctor who will tell the truth and support them no matter what!

There are so many shared values in this holiday season including peace. Although Muslims do not celebrate Christmas, they celebrate the message of Jesus (peace be upon him) everyday. Muslims love Jesus and his mother, The Virgin Mary, as she is described as the most honored woman on Earth with an the entire chapter in the Holy Qura'an named after her. The Prophet Muhammad, Peace Be Upon Him is only mentioned 5 times in the Qura'an, while the Prophet Jesus ( PBUH)was mentioned 25 times. This reflects how Muslims cherish Jesus and his Mother, the Virgin Mary,(peace be upon them) as well as their common message of peace.

Looking at current world events, we know that we have to work together to achieve the common goal of peace similar to the ways of the Prophet Muhammad and Prophet Jesus peace be upon them. Talking is not enough, so proposed remedies and solutions to achieve peace locally and globally are needed. With common enemies such as ignorance and hate there is a duty we all have to combat such notions. As we see in current events, violent terrorists groups are killing innocent civilians with a majority of these casualties being Muslims. Their ideology as well as their actions create a wedge between Islam and the West which as we see is impacting the legislature of bringing refugees, asylum and immigration to the west from the Muslim World.

When we shut the door in the faces of refugees , this creates a recruitment tool for these "thugs" into their twisted ideology. And when they see Islamophobic acts and remarks such as those made by presidential candidate, Donald Trump, they will have even more people believing their sick narrative.

Such reckless, irresponsible and hateful statements will jeopardize world peace and will send a wrong message that would hurt America's image and interests around the world. As for Mr. Trump it will get him disqualification form his candidacy and he will loose his business globally. Contrary to what he claims as a successful business man that he "gets along with everybody" he is actually doing the opposite with his hateful statements such as his false claim that there was cheering after the falling of the world trade center after 9/11 just to get his numbers up in the polls.

So here is a prescription to achieve peace locally and globally:

Support legislation to ban fire arms purchase without going through background checks!

Support the work done by Secretary of DHS Jeh Johnson who visited community mosques and acknowledged their significant contribution in working well with law enforcement. Such actions will push terrorists groups such as ISIS out of their propaganda business as America will stand united against them and their sick ideology. Similarly, FBI Director, James Comey has expressed the excellent relationships with the Muslim community claiming that they have been very helpful.

During this holiday season with so many parties and gift exchanges, as it has always been, give generously and invite your neighbors, Muslim, Christian or Jewish do not differentiate and do not let such hatred come between the positive relationships you have with one another. Together we can fight ignorance, hunger, disease, hatred and global climate change and bring peace on Earth to all of us.

Feeling of physical and emotional exhaustion , reduced sense of accomplishment, negative attitude towards patients or their concerns all constitute symptoms of ( Physician burnout syndrome) which is on the rise in America!

After so many long years of extensive studying, testing, training, and big loans owed , now there is a greater number of physicians either retiring early or change careers all together!

Why?, their work load increased with less revenues , more bureaucracy, regulations,paperwork, and since more doctors have no ( business experience ) , they have lost control!

With mounting daily pressure on physicians to survive financially and navigate the long list of challenges just to be able what they were trained to do which is taking care of people, they are wondering daily if there is anything left for them after paying all the over head costs or at least break even!

Although doctors control 100% of healthcare dollars, they get paid less and less when compared with CEOs and administrators and this was verified by published Medicare data. The CEOs and administrators get to make all Business-related decisions and physicians ( have to do what they were told if they want to keep their jobs!)

Even with that, doctors are loosing jobs from hospitals, healthcare systems, insurance companies and even retail clinics as they are being replaced by ( cheaper labor provided by Nurse Practitioners) under growing financial stresses again to keep overhead down. So , doctors have to lead again this time in the ( Healthcare Business ) in addition to delivering healthcare to be able to thrive financially and continue to provide care for patients.

I am very concerned about the long ignored ,non publicized ( physician burnout which is in some survey studies reached as high as 60% among practicing physicians) and will lead sadly in some instances to an alarming rate of physician suicide when physicians loose control, income, job, and ability to function as a healer not as a ( slave)! so here are some practical solutions that will help both physicians and patients alike

1. Adopt Direct Care Medicine between physicians and patients without the third party added stress and hassle to both especially when the doctors are doing fine job serving their patients.

2. Adopt cost effective Healthcare strategy with early detection and management of diseases which will prevent costly hospitalizations and procedures . The data are very robust and reproducible not only in our ( Concierge Medicine Program) but others as well with direct relationship between patient and doctor have shown better outcome and significant savings to patient, as well as employer and insurance company .

4. Adopt evidence -based medicine guidelines and established protocols in various disease entities to help cut down healthcare cost to the patient .

5. Invest in your personal relationship with your patient to build the trust which makes the practice of medicine very special!

Together as physicians , we can restore the dignity of the patient and the honor of our noble profession bypassing the third party control and abuse which has contributed to physician burnout in a free healthcare market. After all, a good caring doctor brings added value which can never be replaced !

Recent article showed 8 hospitals filed for bankruptcy protection or actually closed since October and it is happening all over the country as more than 50 hospitals already shut down mostly serving rural America before!

For example, St. Mary Hospital in Illinois plans to discontinue services and sell to another company which may use it as an outpatient facility!

Bonnie Memorial Hospital in Texas lost critical vote to get property tax revenues and the Board started to shut down the facility with loss of hundreds of jobs. In East Orange General Hospital , New Jersey has been financially troubled and filed for bankruptcy. Pioneer County Hospital in Newton, Miss. closed their ER doors on Dec.1st as the ( operations of hospital became no longer financially feasible!

Forest Park Medical Center Hospital in Dallas, Texas shut down and even employees were told ( sorry, funds will not be deposited into your account today!). New York based summit Park Hospital and nursing care center expected to shut down on December 31st as they were loosing $800.000 per month! In North Carolina , Franklin Medical Center was closed due to declining patient volume !

The question now , what are all these hospitals have in common ?, answer is simple , unhealthy financial structure spending more than you earn as revenue , so the inevitable decision to close hospitals, let go all the employees and all other supporting businesses of various vendors and services also become secondarily devastated. Unfortunately, the pattern of hospital closure started across America in small towns about one year ago and it looks like the pattern of more hospitals closing in 2016 will continue mostly affecting small and medium -sized hospitals!

Hospitals already started to take measures to cut down overhead cost, which will unfortunately include replacing physicians with cheaper ( Nurse Practitioners), replace nurses with minimum wage nurse aids, pharmacists with pharmacy technicians , cut health coast benefits to employees with more out of pocket cost being shifted to the employees and sadly massive lay offs . Some other Hospital systems got more creative and offered ( to issue refunds to unsatisfied patients) ranging from $100 to $2000, as they will download an APP on their mobile phone and communicate their concern and input directly to the hospital system which will issue the refund as ( a Token of appreciation to the patients) according to CEO David Feinberg of the Geisinger Healthcare .http://www.healthcareitnews.com/news/geisingers-bold-move-dissatisfied-patients-offered-refunds

Here are some practical solutions to help prevent further potential hospital closures!

1. Adopt Concierge Medicine programs by teaming up with all small and medium sized medical practices to make a model of partnership to truly serve the community and help lessen the burden of healthcare cost that is unsustainable and crushing the Middle Class even further.

2. Collaborate to bring transparent and discounted ( Hospital- based services) which will help the cash flow cycle and prevent the looming financial crash and closure of hospitals

3. Adopt technology and social media to engage the community and inform them on what is the best way to save cost without compromising the quality of care.

4. Recognize the reality of healthcare shifting trends from in-hospital to out patient ambulatory care with rapid but efficient turn over of patients, then restructure hospitals accordingly.

5. Adopt alternative Medicine strategies and Wellness which is cheap and non invasive to avoid illness which is costly involving risky procedures.

It is crazy with our current healthcare crisis and shortage of doctors that further devastation is taking place in the with further losses affecting local economies that depend on hospitals for jobs, services and vendors all across America!

The issue of transparency in any business in general and in Healthcare in particular is taking front stage because of its critical importance to consumers. A good leading model such as ( Surgery Center of Oklahoma ) is forcing so many other healthcare facilities including hospitals to be transparent with their charges related to different procedures and services.

One good example , when Jon Doe was seen in the Emergency Room close to his residence ( he happens to be a physician) and after he signed in on I Pad all the forms electronically to initiate the services without being able to read anything , then he had an IV line put in and blood work drawn after brief evaluation by the ER doctor ( 45 seconds) , then had an X ray , then EKG .

Few minutes later , ( a Business office Representative in a suit) came along with a computer attached to him , then started asking questions about choices of payment , with best deal if paid in full while in the ER!.

When asked about the itemized bill, only few minutes after blood was drawn for labs, then noted to have a significant portion of the bill was due to CT scan ( Computed Tomography) test and patient then was offered to be admitted for 24 hour observation! , then it was clear when a certain blood test was supposed to be added before the blood test results came back with additional ( $ 4300 ) charged to the bill!. Then patient asked to put a hold on the CT scan till a specific blood test was ordered and only if it is abnormal , then will justify doing the CT scan only then according to well known clinical protocol to be followed in these situations . The ER doctor knew that as he should not have been reminded by an educated patient who happened to be a fellow physician!

Then the ER physician immediately backed off on doing the CT scan after the blood work came back negative and was no justification for the additional $4300 charges added and patient left ER to home feeling very disappointed that a fellow physician would attempt to sell an unnecessary test which is costly and potentially harmful with unnecessary exposure to radiation and IV contrast which could harm the kidney function and have possible allergic reactions! All this for ( Job security) rather than doing what is supposed to be done which is taking care of patients according to established guidelines and protocols rather than bottom line revenue generation for the Employer!

The patient felt there was more business than medicine and he had to be put in a situation to fight the ER bill with the unnecessary expensive testing which has contributed to more stress when leaving the ER that when he first walked in even with supposedly good news with negative testing. It should not be this way. Transparent pricing for each service should be posted on the healthcare facility website to gain patient trust and business!

Are you ready and prepared yet? The risk is being shifted and being ( dumped) on the consumer , that is what is happening and became official. It is seen in many cases whether with the new credit card machines , if you do not update your machine, the risk will be shifted from the financial institution literally to become laid on your shoulder, similarly if you do not ( code it right ) referring to the ICD 10 coding system , you will be delayed and denied payment for your professional medical services even in some cases with hiring professional billers that are well trained in this transition , turning again all the responsibility on the provider who are most likely will have most of the denials and delays in payment!

Similarly , with subprime mortgage crisis , when someone who may not qualify brought home or property and then the bubble burst , and the economy went into a recession, then millions of Americans lost their homes and properties with foreclosures that devastated millions of families and businesses with effects of which still being felt throughout the nation!

So many people struggle to make ends meet and good luck jumping those hoops to make it on a day by day basis, with a significant crunch in the cash flow cycle which is going to impact so many industries , for example the medical offices give business to many suppliers of medical equipment and supplies, hires staff , pay taxes and contribute to overall economy. But those small entities that contribute up to 84% of the total engine of the economy , may come to full stop as the cycle of business is not moving and forcing so many to early retirement or bankruptcy! On the contrary the bigger providers are merging together( for example Anthem merger with Cigna and Humana merger with Atena insurance companies) to get stronger and richer with stronger control of the market leaving consumer with less options and more risk shifting on the patients with more out of pocket expenses , co payments for office visits, testing , deductibles to the point that people are refusing the coverage simply when they add up what they have to pay on top of their insurance ,they will not have enough left to feed their families or pay bills .

The rising trend of risk shifting is not good for consumers as there is no balance and sense of security left anymore . Everyone is afraid to loose their shirt if they get sick !. This is unsustainable and is bound to fail. We have to restore a well balanced model when we all enter into a fair and transparent partnership with all our providers and go back to fair risk sharing rather that devastating and stiffing risk shifting to the consumer with more options. That is why we advocate direct care model to cut unnecessary cost of third party involvement and advocate on patient behalf to put patient first rather that send them to the cleaners!

Before seeking sub-specialist help first the patient needs an authorization to see a sub-specialist that originates from their primary care physician who is serving as the "gate keeper". No problem of having a gate keeper for cost control and monitoring utilization and outcome criteria, but the big challenge is when a free patient is using his or her own choice to go and see a sub-specialist that he or she liked, got impressed with, or simply have been unhappy with the one they currently have. So, if this patient dares to do that on their own, now the saga continues with a lot of hassle in the process. It begins by first getting the records from the primary care physician who would ask for the NPI number which is a National Provider Number then they would ask about the Tax I.D. number for the business of the sub-specialist then would ask about the billing codes used and the level of billing for office visits. And then they would be asked about what tests the patient is going to have and when are these tests going to be done since the referral is only limited for a certain period of time beyond which would expire.

In the mean time, this courageous patient who is seeking help will be either forced to cancel or at least delay seeking help from a sub-specialists until seeing his or her primary care physician even if the patient confirmed that the sub-specialist is a participating provider in that particular insurance company. So the patient will ultimately not be free to choose even from the limited selection given to them and so many sub-specialists who will be blocked from the gate (i.e no referrals) for that patient even if they have verified all the information about the participating sub-specialist even after going through the investigation and verification process. So the patients ultimately have no choice but to go where ever he or she is directed to only when the "gate keeper" decides to let them through!

As patient advocates and pro choice supporter for patients rights would be certainly violated or at least interfered with every time even when a patient attempts to get a second option for his or her medical condition. Eventually it will be up to the consumer to decide when and where to seek help that they trust without being dictated by the "gate keeper". Or even worse, deny the patients access to any sub-specialist especially with high-risk contracts would mean money out of their pockets if they refer patients out and usual message said to the patients "we will take care of everything for you, you don't need to see any other doctor." There has to be a better way where the main focus is providing the best care to the patients rather than collecting the most money!

The good news is, it's not a pink slip but actually has a few pennies to cash on that check. You figure you put a postage for 49 cents in an envelope and the paper work involved in processing the claim, paying the biller, and other assisting staff to prepare the letter and the envelope and all costs involved to comply within the rules to get in the end a few months later, only a few pennies!

It was once explained to me that when a customer leaves a penny as a tip, that would be an insult to the waiter or the waitress that served that customer. But if they have left nothing on the table, maybe they will have an excuse that they forgot to leave a tip. So either a pink slip or a check reading $00.19 would mean an insult to the provider or even qualify as abuse to the provider.

The majority of good ethical providers have to be united and start collaborating together to complement each others services and offer alternative healthcare systems that is both satisfying professionally to doctors and full filling to patients. That would strike a great balance where the patients are getting the care that they deserve and the doctors are being fairly and directly compensated for their services in a transparent way. This would allow those physicians to keep their doors open, and would prevent physician burn out and abuse, protect patient health and advocate for better health at lower costs which has been already proven to be easily accomplished.

One kind of wonders with the persistent annual increase in healthcare costs over the past three decades and more out of pocket cost to consumer and outrageous deductibles, copayment s and less and less being paid for those who actually deliver the care i.e doctors. So who is making the money in the healthcare market not billions but trillions. No wonder so many doctors are switching their practices into Concierge Medicine (direct care medicine). Where their once again in control of how they practice medicine, not being dictated by the employer who is mostly driven by bottom line (revenue generation) rather than doing what is right and ethical.

We have proven in our Concierge Medicine model over the past five years that it is the way to go. Now both patients and providers have come together to reconnect again to preserve the dignity of the patients and the honor of the most notable profession on earth and not worry about the pennies in the checks!